Prognostic factors in stage-I breast cancer: a retrospective study

We studied the case records of all patients presenting with stage-I breast cancer [tumour < 2 cm, no axillary nodes or distant metastases]. All clinical and pathological features were evaluated and findings were correlated with short term treatment failures [local and distant recurrences within 2 years]. An early recurrence was seen in 28% patients. There was no significant differences in the mean age at presentation [44 vs 47 years] or menopausal status [8 Vs 7 years]. Estrogen receptor status was unknown in all the patients. A positive family history of breast cancer was noted in 40% women with tumour relapse against 6% in the non-relapsed group. Associated fibrocystic mammary dysplasia was found in 80% relapsed cases whereas 60% showed lymphatic invasion and tumour necrosis. Vascular invasion was reported in 40% cases. A poorly differentiated histology fibrocystic mammary dysplasia, lymphatic and vascular invasion and tumour necrosis were poor prognostic factors. It was concluded that adjuvant chemotherapy should be given to all patients presenting with stage-I breast cancer and showing poor prognostic factors regardless of the menopausal status

Two patients with dysgerminoma ovary

Dysgerminoma is a rare malignant germ cell tumour of the ovary. This accounts for about 2-5% of all primary malignant ovarian tumours. In this article two case reports are presented. Case-I is that of a young girl who was diagnosed as stage-IV dysgerminoma ovary and was treated with conventional chemotherapy [VAC regimen - Vincristine, Actinomycin-D and cyclophosphamide]. She went into complete remission after 8 months of treatment. The treatment was continued for one year. Case-II is of a young lady who presented with malignant pleural effusion, and huge abdominal recurrence of a dysgerminoma ovary. She received four cycles of PEB regimen - [Cisplatinum, Etoposide and Bleomycin]. She is now in complete remission. Purpose of this discussion is to emphasize that germ cell tumours are highly chemosensitive and curable even in advanced stages

Radiotherapy of cervical cancer: experience with combined brachytherapy and external beam therapy

Invasive cancer of cervix is diagnosed in about 8% of women presenting with malignancy in Pakistan. A significant number of patients present with advanced cancer. These patients are usually treated with combined external beam and intracavitary radiotherapy. Out of the 444 patients included in this study, 2% were in stage I-A, 8% in stage I-B, 24% in stage II-A, 20% in stage II-B, 38% in stage III and 8% in stage IV-A. Two percent patients were in stage IV-B. All of these patients with stage I-A were free of the disease at 2-5 years after radiotherapy. 80% of stage I-B, 75% of stage II-A, 50% of stage II-B and 16% in stage III are still free of local recurrence after 2-5 years of follow up. Patients in stage IV-A could not achieve long term local control with radiotherapy alone. Ten percent of the patients in stage I-B developed distant metastases, 22% of stage II-A, 20% of stage II- B and 19% of stage III developed distant metastases. Local control as well as disease free survival was good in limited disease and local control with radiotherapy alone was poor in locally advanced stages II-B - N- A cancer cervix. Better pelvic control was observed with concomittant chemo-radiotherapy in such patients. Neo adjuvant chemotherapy with Cis-platinum containing regimens is currently being utilized in patients with poor prognostic factors. This strategy is expected to provide long term controls and improved disease free survival rates